Depression, anxiety, mental health, and being transgender

It’s an unfortunate misconception that being transgender is a mental health issue. The fact that it was listed in the Diagnostic and Statistical Manual of Mental Disorders (the DSM) as “gender identity disorder” until 2013 didn’t help matters. That isn’t to say that there aren’t mental health problems that go hand in hand with being transgender, but instead that being transgender itself isn’t a mental health issue.

The primary mental health issue that goes with being transgender is gender dysphoria. Gender dysphoria is specifically the distress that a transgender person feels as the gender they were assigned a birth. Being transgender doesn’t necessarily mean that you have gender dysphoria, and having gender dysphoria doesn’t necessarily mean that you are transgender and wish to transition. This is an important distinction because of the harmful misconception that transgender people are mentally ill. The fact of the matter is that the acknowledging that one has gender dyspohria and taking steps to relieve it can in some cases cure it. In a lot of cases curing gender dysphoria means transitioning. Someone who is transgender and successfully transitioned may no longer experience gender dysphoria.

Unfortunately, in many cases being transgender and mental illness do go hand in hand. Aside from gender dysphoria many transgender people suffer from depression and anxiety. I’ve suffered from depression for most of my life, and anxiety for the past decade, but I only started seeing a psychiatrist about three years ago at the behest of my girlfriend at the time. She also wanted me to start seeing a therapist, but I could never bring myself to take that step. The depression I always felt that I could handle, but my anxiety was getting worse and worse. I would be a bundle of nerves for no reason, and it started affecting everything I did. The stress that anxiety induced was something that I couldn’t just push aside.

My psychiatrist started me on several medications to help with my depression and anxiety. As I became properly medicated, the depression and anxiety lessened, but the gender dysphoria got worse. Perhaps it was because the “happier” I got, the less I could ignore my struggles with gender, or confuse them with feelings of depression and anxiety. Unfortunately I never felt comfortable to talk to my psychiatrist about my gender dysphoria. It was something I just couldn’t bring up. Talking about myself has never been something that I’m good at, and talking about something as serious, personal, and frankly terrifying as gender dysphoria was out of the question.

When I finally came out as transgender, I finally agreed to look for a therapist since I felt that I couldn’t really talk to my psychiatrist about it. I did some Googling and came across the site Psychology Today, which had an invaluable search engine for psychologists and therapists near me. Unfortunately, living in a rural area, my pickings were slim. There was a single therapist that had transgender listed as an issue, and they were an evangelical reverend. I’m not going to disparage religion if that’s something that helps you, but it raised alarm bells of conversion therapy in my mind. Religious and spiritual support is not something I needed or wanted.

I knew finding a therapist would be hard, and from everything I read it might take several tries to find one that worked for me. Broadening the search got me a whopping two extra results. My heart started to sink I read their profiles on the site and picked the one that sounded the best for me. As it turns out, I got extremely lucky. The person I chose ended up being available the very next day.

I was terrified. The feeling of everything happening so much faster than I expected it to began that day. The terror only got worse as the day progressed and the time for therapy drew closer. When I got to the therapist’s office I remember being handed a form to fill out. I wrote depression and anxiety in the space asking why I was seeking therapy. Then, shaking, I scrawled “transgender questioning” in the space as well. I was going to do it. That’s the real reason I was there, and it was no longer time to beat around the bush.

Honestly, that was perhaps the scariest thing that I have ever done. I had to admit to a total stranger, perhaps two total strangers depending on if the receptionist read the form that I was filling out, about possibly being transgender. I don’t remember much of that first therapy session. I remember sitting in the corner of the couch, staring at my hands. I remember mumbling through admitting that I was questioning my gender. I remember wringing my hands and fidgeting. I also remember a strong feeling of relief once the appointment had ended. Being able to talk to someone honestly and openly about my gender dysphoria and my thoughts about being transgender was a huge weight off of my shoulders. For the first time in my life, my depression, anxiety, and dysphoria all felt like they could be manageable.

I can’t emphasize enough how much therapy helped me. So much so that I recommend it to anyone who’s questioning their gender. Unfortunately, therapy has gotten a bad rap. The stigma that goes along with therapy is difficult to get past. Particularly because it’s one of the many attempts to keep transgender people away from getting the help that they need.

Gatekeeping laws put an undue amount of pressure on transgender people to conform to an often strict and old fashioned definition of gender, further the stigma of being transgender as a mental health issue, and sometimes can even be extremely dangerous. Therapy is one of the most common requirements to people who seek to medically or legally transition, often with specific therapists or social workers that a transgender person must convince that, yes, they really are transgender. While therapy can be extremely helpful, making it a requirement to transition is something that I will never advocate. Other gatekeeping methods are to require transgender individuals to present as their preferred gender for a certain amount of time before being allowed to transition, or for transgender individuals to have parental consent.

Despite being a gatekeeping method, I still advocate therapy, but not for the reasons that gatekeepers tend to require it for. Instead of therapy being treated as a roadblock to one’s transition, it should be treated as a part of the transition itself. It should be about a professional who specializes in LGBT issues with the goal of assisting the transgender person in trying to discover what is best for themselves.

Personally, thinking about my therapist as someone who would help me discover myself relieved a lot of the pressure and tension of going to a therapist for the first time. I wasn’t there to convince my therapist that I was transgender, but instead to discover what being transgender meant for me, as well as what it meant for my relationships with my family and friends. It was about deciding if medically transitioning was right for me. It was about managing the hurdles of being transgender in a very conservative part of the midwest. It was about being one extra piece of a support network, that at the time only consisted of my wife.

Therapy was especially valuable to me, because it assisted me not only in my transition and transgender related issues, but also with my depression, anxiety, and relationship issues. There have been several long stretches where my transition and being transgender weren’t even on the topic list of a session. It gave me a person to talk to who’s only bias was towards me being as mentally healthy as possible.

Of course, not every transgender person needs therapy. Despite the fact that it has helped me profoundly, and that I recommend and advocate for it, I am fully capable of admitting that some transgender people simply don’t need the sort of help that therapy provides. Those individuals are the ones least likely to be reading a blog about being transgender, or posting online about their fears and worries regarding their transition. If you’re one of those individuals, informed consent is the solution, and I fully agree that there should be no roadblocks to your leading a happy and fulfilling life as the gender you prefer.

Unfortunately, there are also the people who have tried therapy, and found that it either didn’t work for them, or they didn’t have that important connection with their therapist that getting the most out of therapy really requires. To those individuals, I recommend trying again. Not every therapist’s methods will work for every patient, and that shouldn’t be seen as a failing of the therapist or of the person seeking therapy. I got extremely lucky in finding a therapist that works for me on my first try, but had my initial therapy session gone poorly, or if after a few sessions I decided that it wasn’t working for me, I would have tried again with someone new. At least until I ran out of therapists, but thankfully it didn’t come to that.

To anyone who may be reading this and deciding to get into therapy, my best advice is to open up as honestly as possible. If you’re there because you’re questioning your gender, start with that, regardless of how difficult and terrifying it might be. Get it out of the way, both because you’ll get the most out of therapy if you do, as well as because it’ll be a quick way of finding out if the therapist you’re seeing can truly help you. Remind yourself that you can only get out of therapy what you put in, and putting everything you can into it from the start is, honestly, the best way of doing it.